Transcription of Patients with thyroid dysfunction
1 Patients with thyroid dysfunction 2 ( thyroid dysfunction ) hyperthyroidism hypothyroidism (Nodular thyroid diseases) solitary thyroid nodules multiple nodular goiter. hyperthyroidism ( ) hyperthyroidism (The National Health and Nutrition Examination Survey NHANE III) Subclinical hyperthyroidism Overt hyperthyroidism % Graves disease Atrial fibrillation congestive heart failure Apathetic hyperthyroidism
2 1 1. 2. Warm and moist skin, nail plate nail bed onycholysis, fine tremor, proximal muscle weakness tachycardia Atrial fibrillation, congestive heart failure sympathetic tone overactivity lids lag lids retraction 3. T3 FT4 TSH TSH < mIU/L Thyrotropin TSH hyperthyroidism - Radioactive iodine uptake (RAIU)
3 Graves disease - RAIU 2 4 Graves disease autoimmune disease thyroid stimulating immunoglobulin (TSI) TSH receptor 80 % hyperthyroidism 30-50 7-10 ( diffusedly enlarged goiter) (bruit) 10-30% Graves disease - (Graves ophthalmopathy)
4 Optic nerve compression 20-30% Graves disease - (dermopathy) localized myxedema % Graves disease - thyroid autoantibodies antithyroid peroxidase (TPO) Ab ( Antimicrosomal Ab), Antithyroglobulin Ab, Anti thyrotropin receptor Ab ( ) RAIU uptake 131 thyroid scan 1-2 Toxic multinodular goiter (nontoxic multinodular goiter)
5 thyroid autonomy TSH pemberton s sign 2 thoracic inlet thyroid scan inhomogenous uptake hot nodule hormone Toxic adenoma 30-40 cm.
6 TSH TSH growth factor Follicular adenoma Graves disease thyroid nonfunctioning nodule thyroid scan hot nodule Graves disease thyroid nonfunctioning nodule cold nodule 1 T3 toxicosis T3 FT4 T4 Subacute painful thyroiditis subacute painful thyroiditis adenovirus, echovirus, influenza, coxsackie.
7 Mumps virus 6-12 thyroid follicles follicle euthyroidism hypothyroidism 5-15% permanent hypothyroidism FT4, T3 TSH ESR granulomatous formation multinucleated giant cells thyroid uptake 131I uptake < 5% 3 (Antithyroid medications) (131I) hyperthyoridism Antithyroid Drugs (Thionamides)
8 2 3 propylthiouracil (PTU), methimazole (MMI), carbimazole, MMI active metabolite carbimazole PTU MMI 2 3 thionamides hyperthyroidism 1. definitive treatment Graves disease long term remission 12-18 2. euthyroidism Ablative treatment 3. hyperthyroidism T3.
9 T4 PTU peripheral deiodination T4 T3 antithyroid drugs immunosuppression lymphocyte response 2 carbimazole MMI Carbimazole MMI half-life MMI 4-6 PTU 1-2 duration of action PTU 5 MMI 12-24 PTU 2-3 MMI rectal administration (Rectal retention enema) pH Fleet phospho soda
